{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:45:16Z","timestamp":1790185516134,"version":"4.1.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Mixed-phenotype acute leukemia (MPAL) is a rare type of acute leukemia with an incidence of less than 5% and Philadelphia chromosome-positive (Ph+) represents a distinct subtype.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case description<\/jats:title><jats:p>An 18-year-old female complained of recurrent fever with fatigue and chills for one month, and a week of growing lymphadenectasis. Bone marrow examination revealed two distinct populations of blast cells and the presence of <jats:italic>BCR::ABL1<\/jats:italic> fusion gene, leading to a diagnosis of Ph+ MPAL. The patient received induction chemotherapy of DVAP regimen combined with tyrosine kinase inhibitors (TKIs), and underwent allogeneic hematopoietic stem cell transplantation after achieving complete remission. To date, the patient has maintained sustained hematological and molecular complete remission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A literature review of 59 cases revealed that Ph+ MPAL is more common in adult, male patients and primarily manifests as B\/myeloid subtype. Higher leukocyte counts and chromosome -7 abnormalities have been identified as poor prognostic markers. Acute lymphoblastic leukemia-type therapy is considered more effective for patients with MPAL, and in the TKI era Ph+ has become a subtype with a better prognosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1623528","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T04:10:30Z","timestamp":1753416630000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Philadelphia chromosome-positive mixed-phenotype acute leukemia: a case report and literature review"],"prefix":"10.3389","volume":"15","author":[{"given":"Liqing","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meijuan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanzhong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"B1","article-title":"Definition of acute biphenotypic leukemia","volume":"82","author":"Matutes","year":"1997","journal-title":"Haematologica"},{"key":"B2","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s00277-020-04354-2","article-title":"Acute lymphoblastic leukemia-like treatment regimen provides better response in mixed phenotype acute leukemia: a comparative study between adults and pediatric MPAL patients","volume":"100","author":"Rasekh","year":"2021","journal-title":"Ann Hematol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1093\/ajcp\/aqac070","article-title":"How I diagnose acute leukemia of ambiguous lineage","volume":"158","author":"Weinberg","year":"2022","journal-title":"Am J Clin Pathol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-03-209262","article-title":"The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes","volume":"114","author":"Vardiman","year":"2009","journal-title":"Blood"},{"key":"B5","article-title":"Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL)","volume":"9","author":"Bene","year":"1995","journal-title":"Leukemia"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01613-1","article-title":"The 5th edition of the world health organization classification of haematolymphoid tumours: myeloid and histiocytic\/dendritic neoplasms","volume":"36","author":"Khoury","year":"2022","journal-title":"Leukemia"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-10-314682","article-title":"Mixed-phenotype acute leukemia: clinical and laboratory features and outcome in 100 patients defined according to the WHO 2008 classification","volume":"117","author":"Matutes","year":"2011","journal-title":"Blood"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2012.064485","article-title":"Clinical, immunophenotypic, cytogenetic, and molecular genetic features in 117 adult patients with mixed-phenotype acute leukemia defined by WHO-2008 classification","volume":"97","author":"Yan","year":"2012","journal-title":"Haematologica"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-018-3297-6","article-title":"An update on classification, genetics, and clinical approach to mixed phenotype acute leukemia (MPAL)","volume":"97","author":"Khan","year":"2018","journal-title":"Ann Hematol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"24290","DOI":"10.1038\/s41598-021-03709-7","article-title":"The association of complex genetic background with the prognosis of acute leukemia with ambiguous lineage","volume":"11","author":"Huang","year":"2021","journal-title":"Sci Rep"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1080\/10408363.2020.1829537","article-title":"The genomic and biological complexity of mixed phenotype acute leukemia","volume":"58","author":"Andrews","year":"2021","journal-title":"Crit Rev Clin Lab Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"11259","DOI":"10.3390\/ijms231911259","article-title":"Genomic landscape of mixed-phenotype acute leukemia","volume":"23","author":"Hennawi","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-018-0436-0","article-title":"The genetic basis and cell of origin of mixed phenotype acute leukaemia","volume":"562","author":"Alexander","year":"2018","journal-title":"Nature"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.v93.11","article-title":"Genomic and clinical characterization of B\/T mixed phenotype acute leukemia reveals recurrent features and T-ALL like mutations","volume":"93","author":"Mi","year":"2018","journal-title":"Am J Hematol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1111\/bjh.2013.163.issue-1","article-title":"Cytogenetic abnormalities in acute leukaemia of ambiguous lineage: an overview","volume":"163","author":"Manola","year":"2013","journal-title":"Br J Haematol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-10-187351","article-title":"Acute mixed lineage leukemia in children: the experience of St Jude Children's Research Hospital","volume":"113","author":"Rubnitz","year":"2009","journal-title":"Blood"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2009.009282","article-title":"Clinical characteristics and outcome of children with biphenotypic acute leukemia","volume":"94","author":"Al-Seraihy","year":"2009","journal-title":"Haematologica"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022016867","article-title":"Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN","volume":"140","author":"Dohner","year":"2022","journal-title":"Blood"},{"key":"B19","doi-asserted-by":"publisher","first-page":"43","DOI":"10.6004\/jnccn.2024.0007","article-title":"Chronic Myeloid Leukemia, Version 2.2024, NCCN clinical practice guidelines in oncology","volume":"22","author":"Shah","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2011.04.011","article-title":"Incidence of Philadelphia-chromosome in acute myelogenous leukemia and biphenotypic acute leukemia patients: And its role in their outcome","volume":"35","author":"Atfy","year":"2011","journal-title":"Leuk Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-011-0953-1","article-title":"Clinical characteristics and outcomes of mixed phenotype acute leukemia with Philadelphia chromosome positive and\/or bcr-abl positive in adult","volume":"94","author":"Wang","year":"2011","journal-title":"Int J Hematol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3343\/alm.2014.34.1.60","article-title":"Four cases of chronic myelogenous leukemia in mixed phenotype blast phase at initial presentation mimicking mixed phenotype acute leukemia with t(9;22)","volume":"34","author":"Choi","year":"2014","journal-title":"Ann Lab Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.55.5223","article-title":"Two elderly patients with philadelphia chromosome positive mixed phenotype acute leukemia who were successfully treated with dasatinib and prednisolone","volume":"55","author":"Takata","year":"2016","journal-title":"Intern Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24295","article-title":"Philadelphia-positive dimorphic blasts in mixed-phenotype acute leukemia with TET2 mutation","volume":"91","author":"Jain","year":"2016","journal-title":"Am J Hematol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3343\/alm.2017.37.2.166","article-title":"A case of therapy-related acute leukemia with mixed phenotype with BCR-ABL1 after treatment of diffuse large B-cell lymphoma","volume":"37","author":"Yang","year":"2017","journal-title":"Ann Lab Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-015-2443-7","article-title":"A rare case of acute leukemia of ambiguous lineage overexpressing C-MYC with monosomy 7 and Philadelphia chromosome","volume":"94","author":"Xu","year":"2015","journal-title":"Ann Hematol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000010294","article-title":"Durable remission in a patient of mixed phenotype acute leukemia with Philadelphia chromosome-positive treated with nilotinib and lenalidomide: A case report","volume":"97","author":"Lai","year":"2018","journal-title":"Med (Baltimore)"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.703612","article-title":"Case report: the formation of a truncated PAX5 transcript in a case of ph-positive mixed phenotype acute leukemia with dic(7;9)(p11-p13;p13)","volume":"11","author":"Yu","year":"2021","journal-title":"Front Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-014-1531-0","article-title":"Successful treatment of Philadelphia chromosome-positive mixed phenotype acute leukemia by appropriate alternation of second-generation tyrosine kinase inhibitors according to BCR-ABL1 mutation status","volume":"99","author":"Kawajiri","year":"2014","journal-title":"Int J Hematol"},{"key":"B30","article-title":"Mixed phenotype acute leukaemia with t(9,22), BCR-ABL1: A case report","volume":"42","author":"Yong","year":"2020","journal-title":"Malays J Pathol"},{"key":"B31","article-title":"First case of biphenotypic\/bilineal (B\/myeloid, B\/monocytic) mixed phenotype acute leukemia with t(9;22)(q34;q11.2);BCR-ABL1","volume":"46","author":"Kim","year":"2016","journal-title":"Ann Clin Lab Sci"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2011.07.010","article-title":"Therapy-related acute leukemia with mixed phenotype and t(9;22)(q32;q11.2): a case report and review of the literature","volume":"43","author":"Cho","year":"2012","journal-title":"Hum Pathol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.4084\/mjhid.2012.024","article-title":"A study on the expression of BCR-ABL transcript in mixed phenotype acute leukemia (MPAL) cases using the reverse transcriptase polymerase reaction assay (RT-PCR) and its correlation with hematological remission status post initial induction therapy","volume":"4","author":"Bhatia","year":"2012","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.2017.5.issue-4","article-title":"Mixed phenotype acute leukemia with t(9;22): success with nonacute myeloid leukemia-type intensive induction therapy and stem cell transplantation","volume":"5","author":"Chan","year":"2017","journal-title":"Clin Case Rep"},{"key":"B35","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1111\/ejh.2014.93.issue-4","article-title":"Philadelphia chromosome-positive mixed phenotype acute leukemia in the imatinib era","volume":"93","author":"Shimizu","year":"2014","journal-title":"Eur J Haematol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e04126","DOI":"10.1002\/ccr3.4126","article-title":"Efficacy and safety of low-dose imatinib in an elderly patient with mixed phenotype acute leukemia with t(9;22)(q34;q11.2);BCR-ABL1","volume":"9","author":"Okayama","year":"2021","journal-title":"Clin Case Rep"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.61","article-title":"Differential signaling through p190 and p210 BCR-ABL fusion proteins revealed by interactome and phosphoproteome analysis","volume":"31","author":"Cutler","year":"2017","journal-title":"Leukemia"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2008.003202","article-title":"Clinical and biological characteristics of adult biphenotypic acute leukemia in comparison with that of acute myeloid leukemia and acute lymphoblastic leukemia: a case series of a Chinese population","volume":"94","author":"Xu","year":"2009","journal-title":"Haematologica"},{"key":"B39","doi-asserted-by":"publisher","first-page":"107309","DOI":"10.1016\/j.leukres.2023.107309","article-title":"Acute leukemias with complex karyotype show a similarly poor outcome independent of mixed, myeloid or lymphoblastic immunophenotype: A study from the Bone Marrow Pathology Group","volume":"130","author":"Kirtek","year":"2023","journal-title":"Leuk Res"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2015.03.012","article-title":"Survival of patients with mixed phenotype acute leukemias: A large population-based study","volume":"39","author":"Shi","year":"2015","journal-title":"Leuk Res"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-018-0058-4","article-title":"Therapy for children and adults with mixed phenotype acute leukemia: a systematic review and meta-analysis","volume":"32","author":"Maruffi","year":"2018","journal-title":"Leukemia"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04179-z","article-title":"Favorable outcomes of acute leukemias of ambiguous lineage treated with hyperCVAD: a multi-center retrospective study","volume":"99","author":"Duong","year":"2020","journal-title":"Ann Hematol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"2670","DOI":"10.1038\/s41467-018-04924-z","article-title":"Integrative genomic analysis of adult mixed phenotype acute leukemia delineates lineage associated molecular subtypes","volume":"9","author":"Takahashi","year":"2018","journal-title":"Nat Commun"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1097\/MOH.0000000000000322","article-title":"Mixed-phenotype acute leukemia: current challenges in diagnosis and therapy","volume":"24","author":"Wolach","year":"2017","journal-title":"Curr Opin Hematol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25873","article-title":"Prognostic impact of Philadelphia chromosome in mixed phenotype acute leukemia (MPAL): A cancer registry analysis on real-world outcome","volume":"95","author":"Qasrawi","year":"2020","journal-title":"Am J Hematol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"101195","DOI":"10.1016\/j.blre.2024.101195","article-title":"BCL-2 inhibition in haematological Malignancies: Clinical application and complications","volume":"65","author":"Fowler-Shorten","year":"2024","journal-title":"Blood Rev"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1285406","article-title":"Broadening the horizon: potential applications of CAR-T cells beyond current indications","volume":"14","author":"Karsten","year":"2023","journal-title":"Front Immunol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1623528\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T04:10:31Z","timestamp":1753416631000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1623528\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":47,"alternative-id":["10.3389\/fonc.2025.1623528"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1623528","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,25]]},"article-number":"1623528"}}